Who Drives Alcohol Prevention Research Agenda In Africa?

I just attended the World Psychiatric Association (WPA) Regional Congress in Kampala (WPA 14), Uganda, this past week (Feb.6-8). The theme of the meeting was “Global Mental Health: Innovation and Opportunities for sub- Saharan Africa”. It was an excellent meeting with participants from Australia, Asia, Europe, North America, and of course Africa. I came away with a very important question that I’ve pondered since the conference ended and that is:

Who drives the alcohol prevention research agenda in sub-Saharan Africa?

This WPA regional meeting was very well planned, there were over 120 exciting and informative plenary talks, scientific presentations and posters on a range of psychiatric issues. It was truly a meeting of the minds of those who will drive future mental health research and prevention priorities for the sub-Saharan region. And, it is clearly indisputable that there is an enormous and unmet need for mental health research, prevention and treatment in this region. So, this conference was critically important for so many reasons. Central discussions focused on building mental health capacity, increasing the mental health work force, defining mental health competencies, reducing stigma for mental health disorders, providing accurate diagnoses and many other important aspects of the many needs, particularly in sub-Saharan Africa.

As a psychiatric epidemiologist, I have been trained to study mental disorders in populations and to examine patterns and distributions of illness and to identify those factors that may increase or reduce risk for illness. I have chosen to focus most of my own research on alcohol use among youth and young adults and the factors that increase risk for alcohol use as well as the outcomes of heavy alcohol use, specifically injuries and violence. It is such a fascinating and troubling topic. Unfortunately, alcohol remains an enormous burden to most societies because of the many harmful consequences associated with its use.

So, I was a bit surprised at this WPA regional meeting of psychiatrists, that I did not really hear any discussion of alcohol or other drug use. In fact, I was so fascinated by the absence of a discussion of alcohol and other drug use that I had to look through the entire conference program to count how many of the 120 plenary talks, scientific presentations and posters used a word like “alcohol”, “drug” or “substance use” in their titles. I found only 2.

Of course, there could have been presentations that discussed issues of alcohol or other drug use as part of their research projects or programs, but did not add that to the title of their presentations. But, even so, this absence of alcohol and other substance use research in a meeting of psychiatrists speaks volumes about the scarcity of alcohol and other drug use research underway in sub-Saharan Africa. In fact, I find this alarming.

Uganda, as an example, is often described as a country with one of the highest levels of alcohol per capita consumption in the world, as estimated by the World Health Organization. There are also other countries in the region with very high levels of alcohol use and alcohol-related problems. So, I ask myself, who is driving the agenda for alcohol prevention and research? If it isn’t the leading psychiatrists in the region who are trained to diagnose and treat alcoholism, then who is making this growing burden a priority for both research and prevention?

Perhaps the real question should be, where are the researchers and are they paying attention?

I’m aware of several important alcohol policy initiatives underway in the region and am thankful and optimistic that the many NGOs and alliances that are forming or growing, to tackle this issue will have a substantial impact. Many of these initiatives are focusing on the World Health Organization’s “Global Strategy to Reduce the Harmful Use of Alcohol” which is a true call for action in a global context. But, to drive true change and to have the impact that is needed, we will also need a strategic research agenda for alcohol use prevention research specifically for sub-Saharan Africa that is innovative, bold and that will create the scientific discovery needed to better understand how to best tackle the alcohol problem with scarce resources. This is particularly urgent given the growing investments in alcohol marketing and sales by the alcohol industry in the region. We need to know the big “fives” of epidemiology: why, where, whom, when and how? In other terms, research needs to examine how many people are affected by alcohol, directly and indirectly, why people are using alcohol, where do they consume it, who is at greatest risk, and how can we best prevent the problems? We cannot assume that strategies and findings from different countries and contexts will work in sub-Saharan Africa.

At the WPA meeting, Poster 6 (PO6) was intriguingly titled “What would it take to prepare for, intervene, and/or prevent the looming epidemic of alcohol and substance use disorders for sub-Saharan Africa?” (By authors Ssempijja & Makumbi). That question remains to be answered. I find this a critically important and escalating public health concern and urge us to work together to make a difference and to make a plan to address this “looming epidemic”.